Provider Demographics
NPI:1023291101
Name:PEREZ, JESUSTONO (MA)
Entity type:Individual
Prefix:MR
First Name:JESUSTONO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-2117
Mailing Address - Country:US
Mailing Address - Phone:253-761-6957
Mailing Address - Fax:
Practice Address - Street 1:815 S PEARL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-2117
Practice Address - Country:US
Practice Address - Phone:253-761-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00054878101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor